Claims and Payments

Here you will find the tools and resources you need to help manage your practice’s submission of claims and receipt of payments. Your primary UnitedHealthcare claims resource, the claimsLink tool, is available on Link, the gateway to UnitedHealthcare’s self-service tools.

If you are not satisfied with the outcome of a Claim Reconsideration Request, you may submit a formal Claim Dispute/Appeal using the process outlined in your provider manual.

A formal Claim Dispute/Appeal is a comprehensive review of the disputed claim(s), and may involve a review of additional administrative or medical records by a clinician or other personnel.

UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation. We will contact you if we believe it will take longer than 30 days to render a decision.

Please allow 10 business days from the submission date to enable us to begin processing the review before requesting a status update.

Additional state requirements may apply. Please consult the applicable state Provider Administrative Guide or Manual for more details or contact the provider services center.

HIPAA Claim Edits

UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically. Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.